Kenya + 4 more

Horn of Africa Crisis - Regional Situation Report #6, Reporting period: 19 – 25 August

Special Focus on Measles, Cholera, and Malaria in the Horn of Africa

The three Dadaab area refugee camps in north-eastern Kenya have recorded a significant increase in the number of reported cases of measles. Between January and mid-August, 237 cases of measles (suspected and confirmed) were reported in the camps – 183 of which (or 78 per cent) were reported in July and August alone (See Figure 1). The increase in the number of cases is consistent with the influx of refugees during the same period. Between July and mid-August, six deaths were attributed to measles with a case-fatality rate of 2.5 per cent. There is probably a gross under-reporting of cases and deaths in the camps, especially among new arrivals.

Between July and mid-August 2011, the four refugee camps in Ethiopia’s Dolo Ado area (Kobe, Melkadida, Boklomanyo, and Hilaweyn) and one transit centre reported a total of 166 suspected cases of measles. Kobe has both the highest number of cases and deaths. Fifteen deaths were attributed to measles with a case-fatality rate of 9.0 per cent. Twelve (80 per cent) of the deaths were reported from Kobe camp. The other three measles related deaths were reported in the transit camp.

The major factors for a measles outbreak in Somalia are low coverage, malnutrition, population movements, and over-crowded internally displaced (IDP) camps. During the period January to July 2011, South and Central Somalia alone reported a total of 5,176 suspected measles cases with 1,019 cases reported in the month of July 2011 alone. A total of 31 measles related deaths were reported from the same zone in the month of July 2011. This represents a huge increase compared to the number of cases reported during previous months and during the same period in 2010.

As disconcerting as the increasing number of cases of measles are the increased number of confirmed cholera cases in Mogadishu and the growing reports of acute watery diarrhoea in Kismayo and other crowded urban centres. An urgent multi-sector response to contain the spread of this highly contagious disease is being mounted. The combination of poor sanitation conditions, a shortage of safe water, overcrowding, and high malnutrition rates create optimal conditions for infectious diseases, such as cholera and pneumonia, to spread and increase the number of deaths. About 75 per cent of all cases of acute watery diarrhoea occur among children under the age of five.
July and August saw a significant increase in the number of reported cases of acute watery diarrhoea in South and central Somalia. On 12 August 2011, WHO reported an “alarming rate” of confirmed cholera cases among IDPs in Mogadishu. Banadir hospital in Mogadishu recently recorded 4,686 cholera/AWD cases including 192 deaths. There is a disproportionate burden on children under five. Accounting for 39 per cent of all the confirmed cases, IDPs are also especially vulnerable.
The recent unseasonal rains and localized flooding in northwestern Kenya not only obstructed aid deliveries, but also created conditions conducive to the spread of water borne illnesses. As the possibility of a cholera outbreak now exists, this part of the country must be closely monitored.
Similarly, malaria is a huge concern. With malnutrition increasing the risk of malaria infection, anti-malaria commodities and program support interventions are urgently required. As a result, Kenya, Ethiopia and Somalia have developed and are consolidating their malaria emergency preparedness and response plans. Rapid diagnostic tests (RDTs) are being procured to detect epidemics early and improve diagnostic accuracy, and adequate stocks of artemisinin-based combination therapies (ACTs) are needed to treat all malaria infections quickly to avoid upsurges in malaria. Moreover, preventive and vector control interventions to reduce transmission risks need to be scaled up, and measures to specifically protect IDP populations need to be in place before the transmission peaks following the onset of the September-November rains.
Response Activities:

  • In response to the upsurge in the number of reported measles cases, UNICEF and its partners conducted an integrated measles immunization campaign (with OPV, vitamin A and de-worming) targeting 230,000 children less than 5 years of age in Kenya’s host communities and camps.

  • UNICEF Kenya and Somalia, together with WHO Kenya and Somalia, were engaged in the planning of the campaign together with the Ministry of Health and Sanitation. UNICEF provided vaccines and supplies together with supporting social and community mobilization.

  • A mass vaccination campaign against measles was completed in Ethiopia’s Kobe camp on Monday 15 August targeting children 6 months up to 15 years of age (18,000 refugee children). Initial reports indicate that 12,961 children were vaccinated against measles and 5,540 children against polio in Kobe camp. The campaign is still going on in Malkadida camp so far 6,050 children were vaccinated against polio and 11,000 children were vaccinated against measles. The campaign will continue in the other camps. A total of 5,540 children were vaccinated against polio in Bokolmayo camp.

  • UNICEF Somalia is prepositioning about 700,000 doses of measles vaccines and other supplies to vaccinate children 6 months to less than 15 years in several parts of Mogadishu.

  • Although the rains that have begun in Kenya’s Upper Rift Valley are expected to improve availability of water and pasture, the onset of rains also brings a threat of cholera. UNICEF and other partners are in the process of pre-positioning sanitation and water supplies to avert a potential outbreak. Particular attention has been given to Kakuma town and refugee camp due to the high levels of open defecation and use of unimproved water sources.

  • Orders are being placed for RDTs, ACTs, and drugs for severe malaria while plans are being finalized to distribute insecticide-treated nets in potential malaria hotspots and implement indoor residual spraying in IDP camps. Moreover, measures to reduce parasite and vector reservoirs will be implemented to reduce chances of outbreaks and epidemics.

Sub regional Situation Overview & Humanitarian Needs

  • The humanitarian crisis in the Horn of Africa, caused by a combination of insecurity, drought and hunger at famine levels in southern Somalia, is causing massive displacement within the country and refugee flows across borders into Kenya, Yemen, Ethiopia, and Djibouti. Nearly half of Somalia’s 7.5 million people have been affected by drought, and a quarter of the population has sought refuge in neighboring countries since the beginning of the year. The United Nations has declared famine in five regions of southern Somalia, amid growing concern that the famine could quickly spread across the country and may affect other areas of the Horn of Africa if not addressed through rapid action.

  • Currently, there are some 895,000 Somali refugees and asylum seekers in neighbouring countries, with Kenya, Yemen, Ethiopia and Djibouti hosting more than 90 percent of them (Kenya 507,000; Yemen 195,000; Ethiopia 160,000 Djibouti 18,000.) Some 1.5 million more Somalis are internally displaced, mostly in the south-central part of the country.

  • Current levels of food insecurity in Somalia will most likely persist until December 2011 due to very poor long rains, harvests, and rapidly declining range resources. Latest figures from the Somalia Food Security and Nutrition Analysis Unit’s (FSNAU) show a 15 percent increase in the number of child malnutrition cases, from 390,000 children to 450,000 children, of which 190,000 suffer from severe acute malnutrition. An estimated 336,000 children, representing 75 percent of all malnourished. (OCHA Somalia 23 August)

  • The number of Somalis arriving in Kenya’s Dadaab refugee camps since the beginning of this year has topped 146,000, bringing the total population of the sprawling complex to some 436,000. They continue to arrive at an average of 1,200 per day.

  • The food security situation remains poor across the eastern Horn. About 3.7 million people in Somalia, 3.7 million people in Kenya, 4.8 million people in Ethiopia, and 0.16 million people in Djibouti are in need of assistance.

  • Across the arid and semi-arid lands of northern Kenya, 25 per cent of the communities have had all surface-based water sources dried up while 50 per cent have lost the capacity to pay for water due to deteriorating household incomes. Remaining surface-based water is expected to last only one to two months instead of the usual three to four months. Distances to water sources have increased up to 15 km. While assistance has been scaled-up, the need for water and sanitation continues to increase as the drought situation continues. The prolonged drought has also had a severe impact on children’s access to education and throughout the area with the education of an estimated 508,000 children disrupted.

  • Confirmed cases of cholera and acute watery diarrhea are on the rise, including in Mogadishu, Kismayo (Lower Juba region), and other crowded urban centers. Suspected measles cases have increased by over 660% compared to the same time last year.

  • The total number of Somali refugee population in the four Dollo Ado camps as well as in the transit center stands at 119,897. As of 23 August 2011, the total number of arrivals in August so far stands at 2,938 individuals with 200 to 300 arrivals each day.

*A total of $50.52m (programmable) has been provided as unearmarked “thematic” funding for the current Horn of Africa crisis. ESARO has to date allocated $27.5m of this to Country Offices as follows: Kenya-$3m; Somalia-$19m; Ethiopia-$2m; Eritrea-$3m; Djibouti-$ 0.5m. A balance of $23.02m (programmable) is available for allocation to Country Offices. Of this, $18.39m (programmable) is available in the system for immediate allocation.

** In addition to the $252.92m already received and issued to COs/RO, another $4.25m is being processed by HQ, and $71.59m has been pledged by donors but not yet received. This brings UNICEF's total resource mobilisation efforts for the Horn of Africa to $328.77m (89.5% funded - including pledges).

Next SitRep:

  • 31 August 2011

ANNEX 1: UNICEF Horn of Africa Results Overview: 19-25 AUGUST



 Supplies (900 MT of rice and 1,024 MT of CSB) have arrived in Bay, Hiran, Bakol and in Mogadishu for other regions. These supplies will reach 57,000.

  • A total of 63 MCH and health post kits are being distributed in Mogadishu to serve an estimated 338,000 people.


 In Gedo region, through partner SHRA, two nutrition feeding centres in Luuq were supported with installation of 2 bladders (serving 4,000 persons per day); construction of 6 latrines (3 latrines in each centre) and installation of 2 x 6 hand washing facilities. In Elwak, through partner Soma Action, 1 berkad was completed at Bulo Boru serving 600 persons and 2 wells were rehabilitated in town reaching 600 persons. In Dolo, through partner NCA/ASEP, 3 latrines were constructed at the feeding centre which serves 1,500 persons per day. In addition, 5 latrines were completed at Qanshley, serving 100 IDP households and 1 ground tank (16 square meters) was completed at the MCH.


  • Over 37,000 children in Mogadishu are being supported by UNICEF and partners to attend 155 IDP schools which have remained open over the school break in order to ensure continuity of learning and access to other services for the children enrolled SUPPLIES

  • A total of 15 flights airlifted Nutrition, health and WASH supplies into Mogadishu from 20-25 August. Supplies included 179 Metric tonnes of CSB, to cover the needs of 7,160 families with blanket supplementary feeding. In addition 63 health kits (40 MCH and 23 Health post kits) to benefit approximately 338,000 people at MCH and health posts and 100 basic family water kits for 1,000 families are being distributed in Mogadishu.

  • On 21 August, UNICEF has successfully airlifted five tons of life-saving supplies to Garbahare (Gedo region) in southern Somalia after two years of no airlifts to this area by the humanitarian community. The supplies consisted of micro-nutrients and medicines and high-energy biscuits, to benefit 750 vulnerable children and their families affected by the drought in Garbahare and Bardera.


HEALTH & NUTRITION Drought-affected populations  A total of nine health kits, which are adequate to manage minor illnesses in 80,000 persons for a period of three months, was dispatched as follows: One complete health kit each for Turkana North, Turkana Central and Turkana South districts; one complete health kit each to Mandera, Wajir and Garissa counties in north eastern province, and one complete health kit each for Isiolo, Marsabit and Moyale counties. Dadaab Refugee Camps  1,472 persons aged six month to 29 years reached with measles vaccination at GIZ reception centre in the third week of August.  Sexual and Gender Based Violence is still reported, with five cases of rape reported at GIZ, two below 18 years and three above 18. All the victims received post exposure prophylaxis, emergency contraceptive pills and sexually transmitted infections treatment within the stipulated time periods.


Drought-affected populations

  • In Kakuma town, a total of 14,400 people are benefiting from water treatment supplies (including aqua tabs and PUR). These figures include 2,030 school children from Kakuma Mixed Primary School, who also participate in the school feeding programme.

Dadaab Refugee Camps

  • Seven water distribution points along the Liboi-Dadaab migration route continue to provide 100,000L water per day to both newly arriving refugees and Kenyans in the surrounding host communities. The total number of beneficiaries for these three sites is estimated at 4,000 people.

  • With UNICEF support, Care International continues to undertake hygiene promotion activities in the Dadaab outskirts reaching 2,413 households this week through house-to-house visits.


Dadaab Refugee Camps

  • UNICEF has pitched three tents in three existing schools within Hagadera Camp. A total of 45 tents will be set up in Hagadera, Dagahaley and Ifo ahead of school opening, which will take place on 05 September 2011.

  • 1,500 out of 6,000 primary-school-age new arrivals have been reached through accelerated learning programme managed by CARE with support from UNICEF in two schools in Dagahaley. WFP and UNHCR supported the schools through school feeding and teacher incentives, respectively.



Drought-affected populations

  • 154,462 severely malnourished children were treated from January to June in the six drought emergency affected regions of the country (July data not yet available).

  • From January to date, some 600 additional TFP sites have been established (both Outpatient Treatment Programme sites and stabilization centres), bringing the total number to 8,703 sites.

  • UNICEF has provided 28 electronic scales to enable follow up of the weight gain of children 6 to 12 years.
    Refugee and host community population

  • Currently, 24 mobile health teams continue to provide basic health and nutrition services. On average, such mobile health team provides 40 consultations on per day and consultations are usually for malaria, fever, diarrhea and pneumonia.


Drought-affected populations

  • UNICEF is supporting water trucking in drought affected areas with 16

  • Water treatment chemicals, soap and water containers (focusing on AWD/cholera prevention) were sent to Afar, Amhara, and Oromiya regions and they reached an estimated population of 125,000 people.

  • UNICEF is supporting water trucking in drought affected areas with 16 trucks operational this week, expanding to about thirty trucks in the next week to fill gaps especially in the Somali and Oromiya Regions


 The Rapid Assessment of Learning Spaces supported by UNICEF is being completed with assessment underway in nine conflict affected districts in the Somali Region. When these districts are completed, the government and its partners will have a full mapping of learning spaces in the Oromiya, Afar, Somali and Gambella Regions.



 In order to respond to the measles outbreak, UNICEF and WHO have been assisting the MOH to strengthen the surveillance system and update health staff on case definition, active case finding, and management.

  • UNICEF is promoting and supporting installation of rural telephones in 30 health posts to allow improvement in timely and complete data transmission from the health posts to the districts and from districts to the central level.

  • The number of moderate malnutrition cases reported receiving Wheat Soya Blend (WSB) at the community level has increased from 15,920 to 16,048.


 Hygiene promotion activities are reaching 25,000 people in peripheral areas of Djibouti town, through an action plan signed with the Ministry of Health and the Djiboutian Agency for Social Development (ADDS).